The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score
-
Maryam Moradi
,
Abbas Ali Salamatizadeh
,
Vahid Talebi
,
Mehdi Karami
,
Maryam Farghadani
,
Mohammad Javad Tarrahi
,
Alireza Khosravi
Abstract
Background: We aimed to assess the agreement between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) to determine whether patients with a high coronary artery calcium score (CS) would benefit from CCTA.
Methods: This cross-sectional study was conducted on patients suspected of having coronary artery disease. The patients underwent calcium scoring. The total CS and the number of calcified foci were determined. The calcium score index (CSI) was defined, and coronary arteries were evaluated by CCTA. ICA was performed, and reports of ICA were extracted. All the abovementioned variables were compared. For data analysis, the κ coefficient and the ROC curve were used.
Results: The study population consisted of 195 patients: 124 men (63.6%) and 71 women (36.4%). The median (IQR) value of CS was 529 (229-1042), ranging from 17 to 4717. In all 195 patients, the concordance between the final impression of CCTA and ICA was 90.2%, while the number and type of involved territories were similar at 57.9%. The highest agreement was seen in the left main and right coronary arteries, whereas the lowest agreement was detected in the left anterior descending and the left circumflex artery. The patients were categorized into different CS groups, and in those with a high CS (>1000), the agreement between CCTA and ICA concerning final impression and involved territories was similar to the whole group of patients.
Conclusion: CCTA in patients with a high CS, even exceeding 1000, remains beneficial as the noninvasive available method.
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7. Achenbach S. Coronary CT Angiography: Moving Up on the Risk Scale. J Am Coll Cardiol 2020;75:464-466.
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9. Andrew M, John H. The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging 2015;31 Suppl 2:145-157.
10. Yunaga H, Ohta Y, Kaetsu Y, Kitao S, Watanabe T, Furuse Y, Yamamoto K, Ogawa T. Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT. Eur Radiol 2017;27:2794-2801.
11. Lau GT, Ridley LJ, Schieb MC, Brieger DB, Freedman SB, Wong LA, Lo SK, Kritharides L. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology 2005;235:415-422.
12. Diederichsen AC, Petersen H, Jensen LO, Thayssen P, Gerke O, Sandgaard NC, Høilund-Carlsen PF, Mickley H. Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium. Scand Cardiovasc J 2009;43:337-344.
13. Stolzmann P, Scheffel H, Leschka S, Plass A, Baumüller S, Marincek B, Alkadhi H. Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. AJR Am J Roentgenol 2008;191:1684-1689.
14. Palumbo AA, Maffei E, Martini C, Tarantini G, Di Tanna GL, Berti E, Grilli R, Casolo G, Brambilla V, Cerrato M, Rotondo A, Weustink AC, Mollet NR, Cademartiri F. Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis. Eur Radiol 2009;19:2127-2135.
15. Kuettner A, Burgstahler C, Beck T, Drosch T, Kopp AF, Heuschmid M, Claussen CD, Schroeder S. Coronary vessel visualization using true 16-row multi-slice computed tomography technology. Int J Cardiovasc Imaging 2005;21:331-337.
16. Hoffmann U, Moselewski F, Cury RC, Ferencik M, Jang IK, Diaz LJ, Abbara S, Brady TJ, Achenbach S. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 2004;110:2638-2643.
17. Haase R, Schlattmann P, Gueret P, Andreini D, Pontone G, Alkadhi H, et al. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ 2019;365:l1945.
18. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832.
19. Cademartiri F, Maffei E, Palumbo A, Malagò R, Alberghina F, Aldrovandi A, Brambilla V, Runza G, La Grutta L, Menozzi A, Vignali L, Casolo G, Midiri M, Mollet NR. Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk. Radiol Med 2007;112:969-981.
20. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ, Schoepf UJ, Shaw LJ, Stillman AE, White CS, Woodard PK, Leipsic JA. Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovasc Imaging 2016;9:1099-1113.
21. Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS. Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician. JACC Cardiovasc Imaging 2008;1:460-471.
22. Kalisz K, Buethe J, Saboo SS, Abbara S, Halliburton S, Rajiah P. Artifacts at Cardiac CT: Physics and Solutions. Radiographics 2016;36:2064-2083.
23. Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, Clouse ME, Bush DE, Hoe JW, de Roos A, Cox C, Lima JA, Miller JM. Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification--a subanalysis of the CORE-64 trial. Radiology 2011;261:100-108.
24. Cademartiri F, Mollet NR, Lemos PA, Saia F, Runza G, Midiri M, Krestin GP, de Feyter PJ. Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography. Am J Cardiol 2005;95:1225-1227.
25. Ahn SJ, Kang DK, Sun JS, Yoon MH. Accuracy and predictive value of coronary computed tomography angiography for the detection of obstructive coronary heart disease in patients with an Agatston calcium score above 400. J Comput Assist Tomogr 2013;37:387-394.
26. Kwan AC, Gransar H, Tzolos E, Chen B, Otaki Y, Klein E, Pope AJ, Han D, Howarth A, Jain N, Dey D, Miller RJ, Cheng V, Azarbal B, Berman DS. The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiography. J Cardiovasc Comput Tomogr 2021;15:412-418.
27. Abdulla J, Pedersen KS, Budoff M, Kofoed KF. Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2012;28:943-953.
28. de Agustín JA, Gómez de Diego JJ, Marcos-Alberca P, Mahía P, Rodrigo JL, Luaces M, Núñez-Gil IJ, Ferreiros J, Bustos A, Cabeza B, García-Fernández MÁ, Macaya C, Pérez de Isla L. Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography. Rev Esp Cardiol (Engl Ed) 2018;71:105-109.
2. Andrews J, Psaltis PJ, Bartolo BAD, Nicholls SJ, Puri R. Coronary arterial calcification: A review of mechanisms, promoters and imaging. Trends Cardiovasc Med 2018;28:491-501.
3. Smith ER, Hewitson TD, Holt SG. Diagnostic Tests for Vascular Calcification. Adv Chronic Kidney Dis 2019;26:445-463.
4. Zhang Y, van der Werf NR, Jiang B, van Hamersvelt R, Greuter MJW, Xie X. Motion-corrected coronary calcium scores by a convolutional neural network: a robotic simulating study. Eur Radiol 2020;30:1285-1294.
5. Yano Y, O'Donnell CJ, Kuller L, Kavousi M, Erbel R, Ning H, D'Agostino R, Newman AB, Nasir K, Hofman A, Lehmann N, Dhana K, Blankstein R, Hoffmann U, Möhlenkamp S, Massaro JM, Mahabadi AA, Lima JAC, Ikram MA, Jöckel KH, Franco OH, Liu K, Lloyd-Jones D, Greenland P. Association of Coronary Artery Calcium Score vs Age With Cardiovascular Risk in Older Adults: An Analysis of Pooled Population-Based Studies. JAMA Cardiol 2017;2:986-994.
6. Serruys PW, Hara H, Garg S, Kawashima H, Nørgaard BL, Dweck MR, Bax JJ, Knuuti J, Nieman K, Leipsic JA, Mushtaq S, Andreini D, Onuma Y. Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021;78:713-736.
7. Achenbach S. Coronary CT Angiography: Moving Up on the Risk Scale. J Am Coll Cardiol 2020;75:464-466.
8. Pursnani A, Chou ET, Zakroysky P, Deaño RC, Mamuya WS, Woodard PK, Nagurney JT, Fleg JL, Lee H, Schoenfeld D, Udelson JE, Hoffmann U, Truong QA. Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial. Circ Cardiovasc Imaging 2015;8:e002225.
9. Andrew M, John H. The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging 2015;31 Suppl 2:145-157.
10. Yunaga H, Ohta Y, Kaetsu Y, Kitao S, Watanabe T, Furuse Y, Yamamoto K, Ogawa T. Diagnostic performance of calcification-suppressed coronary CT angiography using rapid kilovolt-switching dual-energy CT. Eur Radiol 2017;27:2794-2801.
11. Lau GT, Ridley LJ, Schieb MC, Brieger DB, Freedman SB, Wong LA, Lo SK, Kritharides L. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology 2005;235:415-422.
12. Diederichsen AC, Petersen H, Jensen LO, Thayssen P, Gerke O, Sandgaard NC, Høilund-Carlsen PF, Mickley H. Diagnostic value of cardiac 64-slice computed tomography: importance of coronary calcium. Scand Cardiovasc J 2009;43:337-344.
13. Stolzmann P, Scheffel H, Leschka S, Plass A, Baumüller S, Marincek B, Alkadhi H. Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. AJR Am J Roentgenol 2008;191:1684-1689.
14. Palumbo AA, Maffei E, Martini C, Tarantini G, Di Tanna GL, Berti E, Grilli R, Casolo G, Brambilla V, Cerrato M, Rotondo A, Weustink AC, Mollet NR, Cademartiri F. Coronary calcium score as gatekeeper for 64-slice computed tomography coronary angiography in patients with chest pain: per-segment and per-patient analysis. Eur Radiol 2009;19:2127-2135.
15. Kuettner A, Burgstahler C, Beck T, Drosch T, Kopp AF, Heuschmid M, Claussen CD, Schroeder S. Coronary vessel visualization using true 16-row multi-slice computed tomography technology. Int J Cardiovasc Imaging 2005;21:331-337.
16. Hoffmann U, Moselewski F, Cury RC, Ferencik M, Jang IK, Diaz LJ, Abbara S, Brady TJ, Achenbach S. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary artery disease in patients at high risk for coronary artery disease: patient-versus segment-based analysis. Circulation 2004;110:2638-2643.
17. Haase R, Schlattmann P, Gueret P, Andreini D, Pontone G, Alkadhi H, et al. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data. BMJ 2019;365:l1945.
18. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832.
19. Cademartiri F, Maffei E, Palumbo A, Malagò R, Alberghina F, Aldrovandi A, Brambilla V, Runza G, La Grutta L, Menozzi A, Vignali L, Casolo G, Midiri M, Mollet NR. Diagnostic accuracy of 64-slice computed tomography coronary angiography in patients with low-to-intermediate risk. Radiol Med 2007;112:969-981.
20. Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, Rybicki FJ, Schoepf UJ, Shaw LJ, Stillman AE, White CS, Woodard PK, Leipsic JA. Coronary Artery Disease - Reporting and Data System (CAD-RADS): An Expert Consensus Document of SCCT, ACR and NASCI: Endorsed by the ACC. JACC Cardiovasc Imaging 2016;9:1099-1113.
21. Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman DS. Moving beyond binary grading of coronary arterial stenoses on coronary computed tomographic angiography: insights for the imager and referring clinician. JACC Cardiovasc Imaging 2008;1:460-471.
22. Kalisz K, Buethe J, Saboo SS, Abbara S, Halliburton S, Rajiah P. Artifacts at Cardiac CT: Physics and Solutions. Radiographics 2016;36:2064-2083.
23. Vavere AL, Arbab-Zadeh A, Rochitte CE, Dewey M, Niinuma H, Gottlieb I, Clouse ME, Bush DE, Hoe JW, de Roos A, Cox C, Lima JA, Miller JM. Coronary artery stenoses: accuracy of 64-detector row CT angiography in segments with mild, moderate, or severe calcification--a subanalysis of the CORE-64 trial. Radiology 2011;261:100-108.
24. Cademartiri F, Mollet NR, Lemos PA, Saia F, Runza G, Midiri M, Krestin GP, de Feyter PJ. Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiography. Am J Cardiol 2005;95:1225-1227.
25. Ahn SJ, Kang DK, Sun JS, Yoon MH. Accuracy and predictive value of coronary computed tomography angiography for the detection of obstructive coronary heart disease in patients with an Agatston calcium score above 400. J Comput Assist Tomogr 2013;37:387-394.
26. Kwan AC, Gransar H, Tzolos E, Chen B, Otaki Y, Klein E, Pope AJ, Han D, Howarth A, Jain N, Dey D, Miller RJ, Cheng V, Azarbal B, Berman DS. The accuracy of coronary CT angiography in patients with coronary calcium score above 1000 Agatston Units: Comparison with quantitative coronary angiography. J Cardiovasc Comput Tomogr 2021;15:412-418.
27. Abdulla J, Pedersen KS, Budoff M, Kofoed KF. Influence of coronary calcification on the diagnostic accuracy of 64-slice computed tomography coronary angiography: a systematic review and meta-analysis. Int J Cardiovasc Imaging 2012;28:943-953.
28. de Agustín JA, Gómez de Diego JJ, Marcos-Alberca P, Mahía P, Rodrigo JL, Luaces M, Núñez-Gil IJ, Ferreiros J, Bustos A, Cabeza B, García-Fernández MÁ, Macaya C, Pérez de Isla L. Impact of Calcium Score on Agreement Between Multidetector Computed Tomography and Invasive Coronary Angiography. Rev Esp Cardiol (Engl Ed) 2018;71:105-109.
| Files | ||
| Issue | Vol 18 No 4 (2023): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v18i4.14828 | |
| Keywords | ||
| Coronary artery disease Coronary angiography Computed tomography angiography Calcium | ||
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How to Cite
1.
Moradi M, Salamatizadeh AA, Talebi V, Karami M, Farghadani M, Tarrahi MJ, Khosravi A. The Value of Coronary Computed Tomography Angiography in Patients with a High Calcium Score. J Tehran Heart Cent. 2023;18(4):288-293.
